1467808980 NPI number — LOTHAIR WILLIAM PENDLETON LCSW

Table of content: LOTHAIR WILLIAM PENDLETON LCSW (NPI 1467808980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467808980 NPI number — LOTHAIR WILLIAM PENDLETON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENDLETON
Provider First Name:
LOTHAIR
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467808980
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
248 E 13800 S
Provider Second Line Business Mailing Address:
SUITE #4
Provider Business Mailing Address City Name:
DRAPER
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84020-5010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-816-1801
Provider Business Mailing Address Fax Number:
801-501-0249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14241 S REDWOOD RD
Provider Second Line Business Practice Location Address:
SUITE # 100
Provider Business Practice Location Address City Name:
BLUFFDALE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84065-5211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-816-1801
Provider Business Practice Location Address Fax Number:
801-501-0249
Provider Enumeration Date:
05/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  135945-3501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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